A computer system is described for cytological report and registration routines in gynecological practice. The sociomedical advantages of the integration of such a computer system with a previously described computer system for organized pynecological health control are pointed out.
With the aim of making it easier for patients with tumours or suspected tumours of the breast to obtain adequate medical advice and treatment, a special breast tumour clinic was established at the Department of Surgery of the University Hospital in Uppsala for women resident in the county of Uppsala. The waiting time was less than one week. In addition to palpation, fine-needle biopsy with cytological examination, mammography and xeroradiography were performed. Close co-operation between a few doctors responsible for the various diagnostic units made it possible to give the patients quick service and contributed to an efficient use of the diagnostic resources. The clinic functioned mainly within the framework of the existing medical care facilities and did not act as a screening project. Over a period of 15 months, 1244 women were examined. 116 had breast cancer, and 5 of these tumours were occult. A comparatively low mean tumour size and a low frequency of lymph node metastases would seem to indicate that the patients came under medical care at a relatively early stage. For recording of the case histories and examination findings, special medical records permitting data processing were used. This has facilitated follow-up of the patients, special checks on certain patient groups, statistical analyses and prospective investigations. We consider that, for the patient, a clinic of this kind offers considerable psychological and financial benefits, and that for the health service as a whole it means increased efficiency and a lower cost per patient. It seems probable that both the patient's and the doctor's delay are reduced.
Gynaecological health controls for the early diagnosis of cervical cancer are being conducted in many parts of the world at large, as also in the major part of Sweden. Even at the local level the health control programme is so extensive as to be well-suited for automatic computer processing. In Uppsala a computer system has been developed, which reduces manual routines to a minimum, while at the same time demanding high standards of discretion, flexibility and possibilities for integration of the health control system with computer systems with, for example, routine cytology, pathology and gynaecological clinical work. The construction of the system enables direct scientific statistical processing to be conducted.
Background The bulking agent NASHA Dx injected into the submucosal layer is effective in the treatment of fecal incontinence (FI) at short-and medium-term follow-up but efficacy after injection in the intersphincteric location is unknown. The aim of this study was to determine the short- and long-term efficacy and safety of NASHA Dx injected into the intersphincteric location for FI. Methods Patients were recruited from referrals to our Department for treatment of FI in November 2008–January 2010. Eligible patients were injected with 8 ml of NASHA Dx. Patients with a subtotal treatment effect were retreated after 2–4 weeks. The change in number of fecal incontinence episodes, the proportion of responders defined as at least 50% decrease in number of FI episodes and side effects were the main outcome measures. Results Sixteen patients, 15 women and 1 man with a median age of 68, 5 (range 44–80) years and a median CCFIS of 15 (range 10–19) were included in the study. The median number of incontinence episodes decreased from 21.5 (range 8–61) at baseline to 10 (range 0–30) at 6 months (p = 0.003) and 6 (range 0–44) at 12 months (p = 0.05). The median number of incontinence episodes in the 11 patients completing the 10-year follow-up was 26.5 (range 0–68). The percentage of responders at 12 months and 10 years were 56% and 27%, respectively. Mild to moderate pain at the injection site was described by 69%. There was one case of mild infection, successfully treated with antibiotics and one implant had to be removed due to dislocation. Conclusions NASHA Dx as an intersphincteric implant improves incontinence symptoms in the short term with moderate side effects and can be used alone or as an adjunct to other treatment modalities. Long-term efficacy was observed in 27%.
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